HCL 7040 Module 6 Healthcare Ethics Written Assignment Example

Please Don't Tell Her: Truth-Telling, Family-Centered Decisions and the Ethics Committee When a Diagnosis Is Terminal

Student Name

MBA in Healthcare Management, Thomas Edison State University

HCL-7040: Healthcare Law

Mentor Name

Month Day, Year

Please Don't Tell Her: Truth-Telling, Family-Centered Decisions and the Ethics Committee When a Diagnosis Is Terminal

Scenario

Mrs. L., a 76-year-old Korean American widow, is admitted to Cedar Bridge, the course's composite Monmouth County hospital, with jaundice and weight loss. Tests show metastatic pancreatic cancer. Before the oncologist meets her, her son and daughter ask the team not to tell her the diagnosis; in their family, they explain, such news is carried by the children so that a parent does not lose hope, and they will make the decisions about treatment. The oncologist is uncomfortable, and the nurse manager requests an ethics consultation. This assignment analyzes the dilemma and proposes how to resolve it.

The Ethical Principles in Tension

The four principles widely used in healthcare ethics frame the conflict (Beauchamp & Childress, 2019). Respect for autonomy supports telling Mrs. L. her diagnosis so that she can make her own choices about treatment and the time she has left. Beneficence and nonmaleficence are invoked on both sides: the family believes that disclosure will harm her by taking away hope, while the team believes that withholding the truth will harm her by denying her the chance to prepare, to say what she wants and to avoid treatments she might refuse. Justice asks that she be treated with the same respect as any other patient, without assuming that her ethnicity determines her wishes.

Research shows that the family's view is not unusual. Blackhall et al. (1995) surveyed older adults in Los Angeles and found that only 47 percent of Korean American respondents believed a patient should be told a diagnosis of metastatic cancer, compared with 87 percent of European Americans, and that Korean American and Mexican American respondents more often favored family-centered decision making. The same study, however, found substantial variation within each group, which means the team cannot know Mrs. L.'s own preference from her background.

What the Law Requires

Law and ethics largely align here. Consent law gives the choice to the patient herself whenever she has capacity, and it entitles her, not her relatives, to the information that choice depends on. Family members have no legal authority to decide for a capable adult or to require clinicians to withhold information from her. But the law also recognizes that patients may waive their right to information and may delegate decisions to others. The legally and ethically sound path is therefore not to accept the family's request on her behalf but to ask Mrs. L. herself what she prefers to hear and whom she would like beside her when choices are made.

A Structured Method: The Four Boxes

Jonsen et al. (2022) offer a method for working through such cases by considering four topics in turn. Under medical indications, the team should be clear about the facts: the cancer is incurable, and the main choices concern chemotherapy that may extend life by months, symptom control and hospice. Under patient preferences, the key question is what Mrs. L. wants to know and who she wants to decide, which can only be learned by asking her, in Korean with a professional interpreter, rather than through her children. Under quality of life, the team should consider what matters to her, such as being at home, avoiding pain or seeing family abroad. Under contextual features, the team should recognize the family's love and cultural values, the role of the children as caregivers, and the hospital's obligations under consent law.

Working through the boxes points to a practical resolution. The oncologist, with an interpreter and the family present, can ask Mrs. L. an open question such as how much she would like to know about her illness and whether she prefers that her son and daughter receive the details and help decide. If she chooses to know, the team tells her with compassion. If she says she wants her children to handle it, that is a valid exercise of her autonomy, and the team documents her delegation.

The Role of the Ethics Committee

Hospital ethics committees owe part of their history to New Jersey. In In re Quinlan (1976), the New Jersey Supreme Court, deciding whether a ventilator could be withdrawn from a young woman who had lost all awareness, suggested that hospitals use ethics committees to review such decisions rather than bringing every case to court. Today ethics committees and consultation services advise rather than decide. In Mrs. L.'s case, the consultant's role is to facilitate the conversation described above, help the team and family understand each other, and document a plan that respects her choice. If conflict persisted, the committee could recommend further steps, but it would not override a capable patient's wishes.

Conclusion

The family's request reflects real cultural values, and research confirms that many older Korean Americans prefer family-centered disclosure. But ethics and law agree that the decision belongs to Mrs. L. The right approach is neither to obey the family nor to override it, but to ask Mrs. L. how she wants to receive information and make decisions, with a professional interpreter and the support of an ethics consultation, and to respect her answer.

References

Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press.

Blackhall, L. J., Murphy, S. T., Frank, G., Michel, V., & Azen, S. (1995). Ethnicity and attitudes toward patient autonomy. JAMA, 274(10), 820-825. https://doi.org/10.1001/jama.1995.03530100060035

In re Quinlan, 70 N.J. 10, 355 A.2d 647 (1976).

Jonsen, A. R., Siegler, M., & Winslade, W. J. (2022). Clinical ethics: A practical approach to ethical decisions in clinical medicine (9th ed.). McGraw Hill.